Unknown Individual – Surgery Physician, NPI 1417909730

Unknown Individual is a healthcare provider. based in Jefferson city, Missouri. specializing in Surgery Physician. They hold a License No. R9753 (MO). The NPI Number for Unknown Individual is 1417909730

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1417909730
Phone
(573) 632-5700
Address
1125 MADISON ST
Deactivation Date
1 May 2024
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Capital Region Medical Center, 1125, Madison Street, Jefferson City, Cole County, Missouri, 65101, United States of America

    PO BOX 1107

    JEFFERSON CITY, MO 651015227

    Phone: (573) 632-5700

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 65101)

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Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1417909730 — is the standard way to identify this listing.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Surgery Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Jefferson City, Missouri may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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